AIDS, tuberculosis, and the health care worker

The combination of tuberculosis and infection with the human immunodeficiency virus type-1 (HIV-1) poses an increased hazard to health care workers. In this AIDS Commentary, Dr. Kent Sepkowitz of Memorial Sloan-Kettering Cancer Center and New York Hospital-Cornell Medical Center reviews the current state of our knowledge with regard to the risk to health care workers of infection and active disease due to Mycobacterium tuberculosis, in the setting of HIV-1 infection and in the absence of infection with this virus. The goal of achieving complete protection from tuberculosis for persons working in hospitals and clinic will remain elusive until the rapid diagnosis of pulmonary tuberculosis is possible. Standard infection control measures have been documented to decrease the hazard to nurses, physicians, and other health care personnel. As physicians, it is our responsibility to insure that these measures are used effectively. Evaluation of unproven interventions is badly needed, as premature implementation of these often-expensive measures can result in poorer patient care, a false sense of security among health care personnel, and further strain on the resources to be devoted to inpatient care in the future. Dr. Sepkowitz has raised a number of provocative issues that deserve wide and rigorous discussion.